Prevalence of unjustified emergency department x-ray examination referrals performed in a regional Queensland hospital: A pilot study

Abstract

Introduction: The underpinning principles of radiation protection are justification, optimisation and limitation. Each medical imaging referral that uses ionising radiation must balance the justification of exposure to radiation against the benefits of the examination. Scrutiny of justification is the role of radiographers, for general radiography, and is usually performed using the clinical details provided on the referral. International studies report up to 77% of medical imaging examinations are unjustified or inappropriate. In regional Queensland, justification seems to involve a subjective assessment and enforcement is ad hoc. This study aimed to determine the number of unjustified emergency department x-ray examinations performed in a regional Queensland hospital.

Methods: An audit of the clinical details provided on x-ray referrals and in the medical records was performed on x-ray examinations undertaken within an 11-day period. Justification was determined by compliance with the Government of Western Australia's diagnostic imaging pathways.

Results: Of the 186 referrals assessed, 75.3% were categorised as not having complied with the imaging pathway and were considered unjustified. When the clinical details in the patient's medical record were reviewed, in conjunction with the referral, the unjustified rate reduced to 49.2% of examinations.

Conclusion: Results demonstrate a lack of information transfer by referring clinicians and a lack of compliance with justification requirements for imaging by medical imaging staff. Improved communication regarding the need for imaging, and the refusal of referrals that are not justified, will ensure that patients are only exposed to radiation when clear benefit has been demonstrated.

Keywords: Diagnostic imaging; practice guidelines; radiography; utilisation review.